Abstract
PurposeAssess the performance of breast MRI to diagnose breast cancer in BI-RADS 4 microcalcifications detected by mammography.Materials and methodsThis retrospective, IRB-approved study included 248 consecutive contrast-enhanced breast MRI (1.5T, protocol in accordance with EUSOBI recommendations) performed to further diagnose BI-RADS 4 microcalcifications detected at mammography during a 3-year period. Standard of reference had to be established by histopathology. Routine consensus reading results by two radiologists were dichotomized as positive or negative and compared with the reference standard (benign vs malignant) to calculate diagnostic parameters.ResultsThere were 107 malignant and 141 benign microcalcifications. Malignancy rates were 18.3% (23/126 BI-RADS 4a), 41.7% (25/60 BI-RADS 4b) and 95% (59/62 BI-RADS 4c). There were 103 true-positive, 116 true-negative, 25 false-positive, and 4 false-negative (one invasive cancer, three DCIS; 2 BI-RADS 4c, 1 BI-RADS 4b on mammography) breast MRI findings, effecting a sensitivity, specificity, PPV, and NPV of 96.3% (95%-CI 90.7–99.0%), 82.3% (95%-CI 75.0–88.2%), 80.5% (95%-CI 72.5–87.0%) and 96.7% (95%-CI 91.7–99.1%), respectively.ConclusionMRI is an accurate tool to further diagnose BI-RADS 4a and 4b microcalcifications and may be helpful to avoid unnecessary biopsies in BI-RADS 4a and 4b lesions. BI-RADS 4c microcalcifications should be biopsied irrespective of MRI findings.
Highlights
Mammographic microcalcifications are detected in about one third of screening mammograms and are found in up to 40% of breast cancers [1, 2]
The most recent Breast Imaging Reporting and Data System (BI-RADS) lexicon has eliminated BI-RADS 3 rating for such lesions. This is due to the wide range of malignancy rates that was found for BI-RADS 3 mammographic microcalcifications (0–9.7%) that do not comply with the BI-RADS definition of BI-RADS 3 lesions, which are characterized with a disease prevalence of less than 2% [4, 5]
Since Magnetic Resonance Imaging (MRI) has been shown to exhibit the highest sensitivity and specificity for breast cancer detection in general and an Negative Predictive Value (NPV) of nearly 100% in non-calcified lesions referred for problem solving [10], several studies have tried to see whether MRI can further evaluate mammographic microcalcifications
Summary
Mammographic microcalcifications are detected in about one third of screening mammograms and are found in up to 40% of breast cancers [1, 2]. Reported disease prevalence for BI-RADS 4 mammographic microcalcifications range from 32 to 65.2% and from 91.4 to 100% for BI-RADS 5 rated lesions [5]. Reported Positive Predictive Values (PPVs) for BI-RADS 4 lesions are low, ranging from 20–65.2% as assessed by histopathology [6,7,8,9]. They display great heterogeneity, probably owing to data being pooled from different subgroups (BI-RADS 4a-4c). Since Magnetic Resonance Imaging (MRI) has been shown to exhibit the highest sensitivity and specificity for breast cancer detection in general and an Negative Predictive Value (NPV) of nearly 100% in non-calcified lesions referred for problem solving [10], several studies have tried to see whether MRI can further evaluate mammographic microcalcifications. We sought to investigate whether MRI can safely exclude malignancy in BI-RADS 4 lesions according to the respective BI-RADS 4 rating (a-c)
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